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We sit down with medical student Medha Venigalla to explore the urgent issue of resident sleep deprivation and its impact on health care. We discuss the systemic challenges residents face, including long hours, under-reporting of work, and the culture of overwork. Medha shares insights on how sleep loss not only affects residents’ health but also patient safety, leading to increased medical errors and burnout. We also examine potential policy changes and cultural shifts needed to protect residents and improve care quality.

Medha Venigalla is a medical student.

She discusses the KevinMD article, “The cost of exhaustion: Resident fatigue is a public health emergency.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Medha Venigalla. She’s a second-year medical student. Today’s KevinMD article is “The Cost of Exhaustion: Resident Fatigue Is a Public Health Emergency.” Medha, welcome to the show.

Medha Venigalla: Thank you so much for having me. Happy to be here.

Kevin Pho: All right, so let’s start by jumping into your article, “The Cost of Exhaustion: Resident Fatigue Is a Public Health Emergency.” Before talking about the article itself, what led you to write this one in the first place?

Medha Venigalla: Yeah, so I wrote this article during my first year in medical school. I had heard everyone talk about how hard med school is, and I expected that. But going in, it was definitely an adjustment to fix my study schedule and figure out how my day was going to look. It required time management.

Within that, I started dealing with sleep troubles. Meeting residents, older medical students, and clinicians, I learned that sleep deprivation is a significant problem in the field. Last year, we had an assignment in our health policy class where we were asked to write an op-ed about an issue important to us. I chose resident sleep deprivation as my topic. Sleep is really important to me, and I think it’s important to everyone considering we spend a third of our lives asleep.

Kevin Pho: As a first-year medical student, you said you talked to interns, residents, and senior medical students. Tell us—what did you hear from them, especially regarding sleep?

Medha Venigalla: I heard that everyone loves what they do here. Everyone is really excited to be in medicine, and it’s a privilege to do what medical professionals get to do. But at the same time, it’s important to see yourself as a person. Many residents I spoke to mentioned long hours and how it was stressful, taking a toll on their health, personal wellness, and relationships.

That felt like a significant cause for concern to me and to them as well. Recently, residents at UChicago unionized, calling for better conditions and hours. That showed me that these are real issues people are thinking about and taking action on. I wanted to be a part of that conversation.

Kevin Pho: Tell us about your op-ed for those who haven’t read it.

Medha Venigalla: My op-ed is called “The Cost of Exhaustion: Resident Fatigue Is a Public Health Emergency.” In it, I discussed how resident fatigue negatively affects not only the health of residents but also the health of their patients and others they interact with while experiencing cognitive impairment due to sleep deprivation.

I found some interesting facts while researching. Resident fatigue can lead to increased motor vehicle accidents, posing a danger to others beyond the residents themselves. After shifts that are 24 hours or longer, their cognitive impairment is equivalent to being legally drunk. That’s a major concern when they’re treating patients and holding their health in their hands.

Duty hour limits imposed by the ACGME cap the workweek at 80 hours and shifts at 24 hours. But these regulations need enforcement. There’s underreporting of hours because of the “go, go, go” culture in medicine, where residents feel pressure to perform and impress. This can push people to underreport their hours or not be completely honest about being overworked.

Reputation matters in this field, which sometimes puts mental health on the back burner for trainees. That’s something we need to address collectively as a profession.

Kevin Pho: You mentioned that residents sometimes underreport their hours due to the culture of medicine. Do you have any personal stories—anonymously, of course—where residents specifically said they worked more hours than they reported?

Medha Venigalla: I haven’t personally met anyone who has told me that they’ve done that. Honestly, the culture at UChicago is better than I expected after hearing stories about residency. Residents here have unionized, as I mentioned, so mental health, wellness, and fatigue are issues being brought to the forefront.

However, I’ve read online accounts and seen statistics about residents underreporting hours out of concern for how they’ll be perceived.

Kevin Pho: Regarding the cognitive impairment caused by fatigue, did you find a direct link between fatigue and increased medical errors in your research?

Medha Venigalla: Yes, there is a direct link. Residents working longer shifts have a higher incidence of medical errors. It’s pretty straightforward—if you sleep less, you’re cognitively impaired and more likely to make mistakes. One study found that these mistakes are more likely to lead to fatal outcomes for patients when residents work longer shifts.

Kevin Pho: The ACGME has limited work hours to 80 hours a week and shifts to no longer than 24 hours. What more can be done from a regulatory standpoint?

Medha Venigalla: There’s currently an act in Congress called the Resident Physician Shortage Act. This act aims to increase the number of residency spots in the U.S. to address the physician shortage and reduce the hours residents work.

Capping hours was a step in the right direction, but enforcement is key. Programs need to ensure that residents aren’t slipping through the cracks. Mental health issues and resident suicides still occur despite these regulations. Enforcement and culture change within programs are critical.

Kevin Pho: Some criticisms of duty hour caps suggest they create a shift-work mentality, with physicians handing off patient care more often. What are your thoughts on this as a second-year medical student?

Medha Venigalla: While it may seem like a shift-work mentality, I think residents still take responsibility for their patients’ health and follow them as long as necessary before handing them off. Ultimately, the focus is on providing the best care while recognizing that fatigue can compromise that care.

Kevin Pho: You mentioned that residents at the University of Chicago unionized to address concerns about resident fatigue. Tell us more about that initiative.

Medha Venigalla: Earlier this year, the residents at UChicago unionized. The issues they brought up included pay, working hours, and overall working conditions. They recognized the necessity of long hours—there’s so much training, learning, and work to do before a resident becomes an attending.

However, they wanted better working conditions to ensure they could perform better for their patients and achieve better outcomes for the institution as a whole. This effort had significant support from residents and medical students alike. It was inspiring to see that mental health and wellness for residents are becoming priorities in the field.

Kevin Pho: Among your medical school classmates, what were the reactions when you heard about the residents unionizing?

Medha Venigalla: Many of us were surprised but also optimistic and happy. It was encouraging to see resident wellness becoming a focal point. It speaks volumes about the direction of the field when mental health and wellness are taken seriously. For us as medical students, it’s reassuring to know that this is the future being created for us. It made us feel supported and excited for what lies ahead.

Kevin Pho: Burnout sometimes starts as early as medical school. Are you seeing any initiatives to reduce burnout and ease the pressure on medical students?

Medha Venigalla: Yes, definitely. One initiative is the widespread adoption of pass-fail grading for preclinical courses across the U.S., which has had a positive impact on mental health. Step 1 is also now pass-fail, which helps reduce some of the stress associated with board exams.

That said, medical students are a hardworking and disciplined group. Even with pass-fail grading, there are still standards we’re expected to meet. But these changes reflect an effort by medical schools to prioritize mental health while maintaining rigorous standards. I think these initiatives are making a difference in reducing burnout among trainees.

Kevin Pho: Is there anything more that could be done to address burnout among medical students and residents?

Medha Venigalla: For residents, I think enforcing the current 80-hour workweek limit is essential. Even with regulations in place, residents can slip through the cracks, and mental health remains a significant issue. There have been tragic cases of resident suicides, such as Will West and Jing Mai, which highlight the need for continued action.

For medical students, while progress has been made, I think grading during the clinical rotation year is an area for improvement. It’s a stressful time because grading can feel subjective and inconsistent across attendings. Adding more objectivity to the evaluation process during rotations could alleviate some of that stress.

Kevin Pho: When you mentioned enforcement of the 80-hour workweek, are you suggesting stricter adherence to existing rules or further reductions in work hours?

Medha Venigalla: I think stricter enforcement of existing regulations would be a great place to start. Programs need to show their residents that they care about their well-being. Mental health and wellness need to be priorities. Even with the 80-hour limit, suicides among residents still occur. Enforcement and cultural change within programs are critical steps toward addressing these issues.

Kevin Pho: We’re speaking to Medha Venigalla, a second-year medical student. Today’s KevinMD article is “The Cost of Exhaustion: Resident Fatigue Is a Public Health Emergency.” Medha, let’s end with some take-home messages you’d like to leave with the KevinMD audience.

Medha Venigalla: Fatigue during residency isn’t just a resident issue—it’s a public health emergency. The health care system needs to take care of our residents so that they, in turn, can take better care of their patients and improve outcomes for everyone. This requires shifting the culture of medicine to one that values the mental health and wellness of physicians. When physicians are cared for, they’re better equipped to care for their patients.

Kevin Pho: Medha, thank you so much for sharing your perspective and insights. Thanks again for coming on the show.

Medha Venigalla: Thank you so much for having me.